2015 Run For Miles Race Form here

RUN FOR MILES
KEEPING HIS MEMORY ALIVE
3RD ANNUAL 5K RUN/WALK
FUN RUN (IN MEMORY OF TOMMY BOURGEOIS)
BERWICK HIGH SCHOOL
APRIL 25, 2015
WWW.MILESLINERFOUNDATION.COM
ENTRY FORM (mail to): The Miles Liner Foundation, Inc.
513 Watson Street Berwick, LA 70342
Name of Participant: _______________________________________________________
*Each Participant Must Complete
a Form.
Age: ______________Phone #_________________________________________________
*If you are making one check for
multiple participants, please include
all forms with the check.
Address: ____________________________________________________________________
City & State: ____________________________________Email:______________________________________________
REGISTER BY MARCH 27TH AND All Participants WILL BE ENTERED INTO EARLY BIRD
CASH DRAWINGS!! (Drawings will be drawn prior to race start)
Shirts and bags are only guaranteed if entry form received by April 15th.
Registration after April 15th or the day of the event, an additional $5 will be assessed for the race chosen.
Check One
REGISTRATION FEE: _____1 MILE FUN RUN…….$15
(Check One)
_____5K WALK/RUN……….$20
* Only 5K participants eligible for prize drawings.
*Must be present to win.
Sign in/Race Day Registration: 7 to 7:45 am
Race Time: 1 mile fun run – 8:00 am
5K run/walk – 8:30 am
RAIN OR SHINE: No make-up date or refunds
AWARDS: All fun run entries receive a medal.
Trophies go to 1st,2nd, 3rd overall male and female.
Medals go to 1st,2nd and 3rd in each age group.
Youth Small
Y Medium
Y Large
Adult Small
Adult Medium
Adult Large
Adult X Large
Adult 2X Large
(add $5)
Adult 3X
Large(add $5)
Amount Paid:
In completing this entry I declare that I, or anyone that I am paying for, will not compete in the event unless medically fit to do so
and that, in any event, we will compete at my/our own risk. I accept that The Miles Liner Foundation, Inc. will not be liable for any
loss, damage, action, claim, costs or expenses which may arise in consequence of my/our participation of the event. I/We
understand that entry fees are non-refundable. I also hereby give my permission to pass my/our details to my chosen charity and to
use my/our name, quotes, video footage, and photographic likeness for marketing and promotional purposes. I also agree to the full
Terms and Conditions as displayed on the event website.
/
PRINT NAME
SIGNATURE (PARENT OR GUARDIAN IF UNDER 18
/2015
DATE